Provider Demographics
NPI:1578842969
Name:KLUG, BRIAN M (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:KLUG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19822 INDIGO KEY CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:832-877-1976
Mailing Address - Fax:
Practice Address - Street 1:19822 INDIGO KEY CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:832-877-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily